Many children resist doing their homework, but most kids say “Its so BORING!” not “My hand hurts too much”. If a child is complaining of pain, and they don’t have a joint disease such as JRA, the first thought is hypermobility. The good news is that there are a few fast fixes that can decrease or even eliminate hand pain.
It is rare that hypermobility in the hand is directly addressed at the preschool level unless it is generalized throughout the body or severely reduces pencil grasp. Many children have atypical grasp patterns when they cannot achieve the required stability for a standard pencil grasp. Children with mild instability and no other developmental issues may still be able to write legibly and even fast enough to complete assignments in the early grades. It is when the volume of work increases or the joint stability decreases that therapists get a request for service.
Here are a few strategies that can support hypermobile kids to write with less pain:
- Use a tabletop easel. These can be foldable or static. They support not just the wrist and forearm, but also the shoulder and trunk. The angle of an easel both supports correct wrist positioning and decreases strain on the wrist and hand. Some easels come with clips that hold the paper, but they should be placed on an angle to mirror the natural arm position. This will require more table space, so be aware that the size of the easel could be an issue. Simple hack: use a three-ring binder as an easel.
- Enlarge the width of the pencil shaft. My favorite pencils for grades 1+ (see photo above) have a standard #2 lead, but a wider shaft. Joint protection principles tell us that avoiding a closed joint position should lead to less strain on joints and supporting ligament structures. You could use some of the adaptive pens available, but I find kids reject these as looking strange. Of course, if you enlarge the shaft oo much you will find that it is more awkward, not less. Think of those novelty pencils you buy in gift stores on vacation. Cute but useless. Nobody really writes with anything that thick. Match the child’s hand size to the pencil.
- Increase the texture of the pencil shaft for easier grip, less pain, and more endurance. Everyone has seen the rubbery grips you slip onto a pencil. You can slide 3-4 onto the entire shaft, or add some tape to create a non-slip surface. I have been adding kineseotape or Dycem to handles this year, with good results. You are battling grasp stability, but also fatigue. A hand that is tired is a hand that experiences more pain. Adding texture reduces the amount of force needed for proprioceptive registration (a fancy way of saying that kids need to squeeze to fully feel what is in their hand). Reducing force reduces pain and fatigue.
- Teach pacing. Kids think that the faster they write, the faster they will be out of pain. Breaking up the work can have better results, but it isn’t natural for children to pace themselves. In fact, I have never seen a young child do so. You have to teach this to kids who likely will have joint instability throughout their school years. A schedule, a timer, organizing assignments and breaking them down into heavy writing choices and light writing choices all help.
- Splinting can be a real option. Not a heavy plastic or metal splint (usually). A neoprene splint can be a lightweight supportive choice. These splints are comfortable and washable. These are affordable without insurance for most families, and your OT can help you decide if this is a worthwhile pursuit. They are durable but easily lost by younger children, so not all families send one to school. But the support is real, and kids that have been told for years to “fix your fingers” can feel relieved that they can now focus on writing and composing on the paper.
For more information on hypermobility, read The Hypermobile Hand: More Than A Strength Problem and For Kids With Hypermobility, “Listen To Your Body” Doesn’t Teach Them To Pace Themselves. Here’s What Really Helps.
Looking for more assistance with hypermobility? My new e-book is coming out this summer, and it will address the issues of the early years (0-5). The series will continue with school age kids and teens. But you don’t have to wait; visit my website tranquil babies and request a consultation to discuss your child’s treatment plan and make a better plan that works for everyone…today!